Why Is Therapy So Expensive? Understanding the Costs of Quality Care
If you’ve ever sought out therapy and experienced sticker shock at the cost of a session, you’re not alone. Many people wonder why therapy is so expensive and why so many therapists, including myself, don’t accept insurance. Is my therapist overcharging me? Is this the mental health industrial complex prioritizing profit over my well-being? These are fair questions, and the reality is more complex than it might seem. While therapy should absolutely be more accessible—something I feel quite passionate about—the reality is that the financial and systemic challenges therapists face often make private pay the most sustainable option, for now.
Some Hidden Costs of Becoming and Being a Therapist
Therapists don’t just wake up one day and decide to charge high fees—we’ve invested significant time, energy, and money into becoming qualified professionals. Here’s a breakdown of some of the costs involved:
Graduate School Tuition: Master’s programs in counseling, psychology, or marriage and family therapy often cost between $40,000 and $100,000+.
Licensure Fees: After graduation, therapists must complete thousands of hours of supervised clinical work (often for little pay) and then pass licensing exams. These exams, applications, and renewal fees can cost $500–$1,500.
Malpractice Insurance: To protect ourselves legally, therapists need malpractice insurance, which costs $300–$1,000 per year.
Office Space & Overhead: Therapists in private practice must pay rent for their office, cover utilities, maintain electronic health records, and manage administrative costs, often totaling $1,000–$3,000 per month.
Continuing Education & Specialized Training: To maintain licensure and provide high-quality care, therapists must complete continuing education courses and specialized trainings. A single training can cost anywhere from $200 to $5,000.
Other Costs: Unlike salaried employees, private practice therapists don’t receive employer-covered benefits. This means budgeting for health insurance (~$500–$700+/month), unpaid vacation and sick time, and retirement savings (no employer match).
Why Many Therapists Don’t Take Insurance
It would seem logical that insurance should help cover therapy, making it affordable for clients and sustainable for therapists. Unfortunately, that’s not the case. Here’s why many therapists, including myself, choose private pay:
Low Reimbursement Rates: Insurance companies typically reimburse therapists $60–$120 per session, often far below the private pay rate. Given the cost of running a practice, it’s simply not sustainable for many therapists.
Delayed & Denied Payments: Therapists frequently experience long delays in payment from insurance companies, and sometimes claims are outright denied with little explanation.
High Administrative Burden: Dealing with insurance companies requires hours of unpaid administrative work, from submitting claims to fighting denials, taking time away from actual client care.
Loss of Clinical Autonomy: Insurance companies often dictate treatment length and methods, rather than allowing the therapist and client to determine what’s best for care.
An increasing wave of tech companies have stepped in, attempting to address these issues and streamline the insurance reimbursement process. However, many therapists contracting with these tech companies report that they still struggle with underpayment and delayed payments, frustrating restrictions imposed by insurance companies on treatment decisions, and high caseloads leading to burnout.
The Non-typical Schedule of Private Practice Therapists
The income of private practice therapists can be misleading because their work doesn’t follow a typical 40-hour schedule. When people see an hourly rate, they often assume it reflects a full-time workload, but private practice therapists are only paid for client sessions. A significant amount of unpaid time is spent on record-keeping, billing, responding to emails and calls, coordinating care, and other administrative tasks.
Client-facing hours vary depending on a therapist’s capacity to sustainably manage a caseload. Research suggests that for optimal client care and reduced burnout, private practice therapists should ideally see 15–20 clients per week. Those who take on more than 20–25 clients, especially in trauma-focused or emotionally intense work, are at a significantly higher risk of burnout and compassion fatigue due to the emotional demands of the profession.
The Reality of Pay for Therapists on Online Therapy Subscription Platforms
While platforms like BetterHelp and Talkspace may appear to offer affordable therapy, in my opinion, they often pay their therapists significantly less than what is typical in private practice. Some therapists on these platforms have reported earning as little as $30–$50 per session, based on public forums and personal accounts shared by those who work there. This model appears to prioritize volume over quality, with therapists sometimes needing to take on 30+ clients per week just to earn a living wage—potentially leading to burnout and a reduction in the quality of care.
Therapist caseloads vary widely depending on work setting, impacting stress levels and burnout risk. A sustainable workload allows for better client care and therapist well-being, while high caseloads can lead to burnout and compassion fatigue. Here’s how different therapy settings compare:
Therapist Caseload & Burnout Risk: How Work Setting Impacts Well-being
🟩 Green Zone (15-20 Clients) – Sustainable Caseload, Lower Burnout Risk
✅ Private Pay Therapists in Private Practice
✅ Specialized/Niche Therapists (EMDR, trauma-focused, high-fee)
✅ More time for self-care, training, and client well-being
🟧 Orange Zone (20-25 Clients) – Moderate Caseload, Higher Burnout Risk
⚠️ Insurance-Based Private Practice Therapists
⚠️ Pre-Licensed Therapists (Associates in agencies/group practices)
⚠️ Community Mental Health Therapists
⚠️ Balancing high documentation demands, lower pay, and more clients
🟥 Red Zone (30+ Clients) – Heavy Caseload, High Burnout Risk
❌ Subscription-Based Online Therapy Therapists
❌ Agency & Crisis Workers (Medicaid-funded agencies, crisis response)
❌ High turnover, emotional exhaustion, limited time per client
The Value of Private Pay (Out of Network) Therapy
Many therapists, myself included, choose private pay because it allows us to provide high-quality, individualized care while maintaining a sustainable workload. A therapist who sees 15–20 clients per week at a livable rate can offer more energy, attention, and presence to each client compared to a therapist seeing 25–30+ clients just to survive.
Investing in Your Well-Being
I understand that private pay therapy is a financial commitment, and it’s not accessible for everyone. But if you’re able to invest in this kind of care, you’re not just paying for an hour of a therapist’s time—you’re investing in the work that makes therapy effective. This includes the preparation before each session, years of education and experience, ongoing professional growth, and most importantly, the ability to be fully present and attuned to your needs.
If cost is a concern, many private pay therapists offer sliding scale fee options, superbills for out-of-network reimbursement, or referrals to lower-cost options. Many people (especially those with PPO plans) have out-of-network benefits but don’t take advantage of them simply because they don’t know about them. These benefits are not well-advertised by insurance providers largely because these providers have a financial incentive to steer members toward in-network providers.
To simplify the reimbursement process, clients can use Thrizer, a great company that streamlines the submission of out-of-network claims for easier reimbursement. I advocate for my clients by helping them navigate all of these options, ensuring they receive any reimbursement they’re entitled to. Additionally, Open Path Collective is a fantastic nonprofit that connects clients with therapists offering a select number of low-cost sessions, typically ranging from $30–$70 per session—about the same an an insurance co-pay.
Ultimately, therapy is an investment in your well-being, and finding the right fit—both financially and clinically—is essential. If you have any questions about navigating this system, therapy costs or private pay, I’d be happy to chat more about what would work best for you!